SCS Plus HIPEC Improves Recurrent Ovarian Cancer Outcomes Amid Safety Concerns

The combination of secondary cytoreductive surgery (SCS) and hyperthermic intraperitoneal chemotherapy (HIPEC) may improve overall survival (OS) in patients with platinum-sensitive recurrent ovarian cancer (PSROC) without a significant increase in the incidence of severe (grade ≥ 3) complications, according to a study published in the World Journal of Surgical Oncology.1

Secondary cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy improves overall survival in platinum-sensitive recurrent ovarian cancer but increases the risk of severe adverse events. | Image Credit: tashatuvango - stock.adobe.com

Investigating the Uncertain Survival Benefit of SCS Plus HIPEC for PSROC

The researchers noted that the National Comprehensive Cancer Network recommends SCS followed by platinum-based chemotherapy for individuals with PSROC who are in adequate physical condition and have a limited number of recurrent lesions.2 The primary objective of SCS is to reduce tumor burden and delay disease progression through maximal resection of macroscopic recurrent lesions.1 When performed in appropriately selected patients, SCS may yield better survival outcomes than nonsurgical approaches such as chemotherapy alone.

The researchers added that HIPEC has emerged as an adjunctive strategy in ovarian cancer treatment. Typically administered immediately following interval cytoreductive surgery, HIPEC involves the intra-abdominal infusion of heated chemotherapeutic agents to enhance cytotoxicity and tissue penetration; meanwhile, the lavage process helps clear free tumor cells and microscopic residual disease.

Because HIPEC has shown potential survival benefits in primary ovarian cancer, interest has grown in its use following SCS in PSROC. However, the survival advantage of combining SCS with HIPEC in this population remains unclear.

To address this gap, the researchers conducted a systematic review and meta-analysis evaluating the efficacy and safety of SCS plus HIPEC vs SCS alone in patients with PSROC. They explained that the analysis “aims to provide high-quality, evidence-based data to support clinical decision-making in the management of recurrent ovarian cancer.”

The researchers performed a comprehensive search for relevant studies in the PubMed, EMBASE, Web of Science, and Cochrane Library databases through December 31, 2024. They considered studies to be eligible if they compared outcomes between the 2 treatment strategies.

Primary outcomes included progression-free survival (PFS) and OS, assessed using HRs with 95% CIs. Additionally, secondary outcomes included the incidence of complications, reported as relative risks (RRs) with 95% CIs.

SCS Plus HIPEC Demonstrates Survival Benefit in PSROC but Raises Risk of Adverse Outcomes

Of the 4533 relevant articles initially identified, the researchers included 7 in their analysis. The 4 randomized controlled trials (RCTs) and 3 cohort studies published between 2014 and 2024 included 1136 patients with PSROC. Among them, 563 received SCS plus HIPEC, and 573 received SCS alone.

A meta-analysis of 6 studies reporting PFS showed a trend toward improved PFS in the SCS plus HIPEC group compared with the SCS cohort, though the difference was not statistically significant (HR, 0.91; 95% CI, 0.72-1.15; P = .034). Regarding OS, a meta-analysis of 6 studies demonstrated a statistically significant benefit for patients who received SCS plus HIPEC (HR, 0.74; 95% CI, 0.62-0.87; P = .241).

Severe adverse event data were available from 6 studies. Although the risk of complications was higher in the SCS plus HIPEC group, the difference did not reach statistical significance (RR, 1.42; 95% CI, 1.00-2.01).

Among specific adverse events, anemia was reported in 4 studies, while thrombocytopenia and nephrotoxicity were each reported in 3. Pooled results indicated a significantly increased risk of anemia (RR, 1.38; 95% CI, 1.18-1.62; P = .473) and nephrotoxicity (RR, 1.71; 95% CI, 1.20-2.43; P = .776) in the SCS plus HIPEC group. In contrast, the researchers did not observe a significant difference in thrombocytopenia incidence between groups (RR, 1.41; 95% CI, 0.76-2.59; P = .212).

Next Steps in Evaluating the Efficacy, Safety of SCS Plus HIPEC in PSROC

The researchers acknowledged their limitations, including potential selection bias due to the inclusion of both randomized and non-randomized studies. Also, variability in the timing and reporting of complications across studies may have affected the precision of safety outcomes. Still, they emphasized the clinical relevance of the findings and highlighted opportunities for further research.

“Future research should focus on establishing standardized intervention protocols for HIPEC and implementing large-scale randomized controlled trials to further evaluate its efficacy and safety in well-defined patient populations,” the authors concluded.

References

1. Liu HY, Tian LH, Huang G, Li N. Efficacy and safety of secondary cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in platinum-sensitive recurrent ovarian cancer: a systematic review and meta-analysis. World J Surg Oncol. 2025;23(1):423. doi:10.1186/s12957-025-04076-7
2. Liu J, Berchuck A, Backes FJ, et al. NCCN Guidelines® Insights: Ovarian cancer/fallopian tube cancer/primary peritoneal cancer, version 3.2024. J Natl Compr Canc Netw. 2024;22(8):512-519. doi:10.6004/jnccn.2024.0052